About two-thirds of the assertions that different risk factors exist for African Americans found in a widely used pathology textbook could not be supported by the published literature. Failure to separate race from other socioeconomic and behavioral characteristics as risk factors for certain diseases may contribute to the misdiagnosis of patients and interfere with efforts to identify and remove causes of health disparities.

Background and objectivesAKI is a common complication of coronavirus disease 2019 (COVID-19) and is associated with high mortality. Palliative care, a specialty that supports patients with serious illness, is valuable for these patients but is historically underutilized in AKI. The objectives of this paper are to describe the use of palliative care in patients with AKI and COVID-19 and their subsequent health care utilization.Design, setting, participants, & measurementsWe conducted a retrospective analysis of New York University Langone Health electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020. Regression models were used to examine characteristics associated with receiving a palliative care consult.ResultsAmong patients with COVID-19 (n=4276; 40%), those with AKI (n=1310; 31%) were more likely than those without AKI (n=2966; 69%) to receive palliative care (AKI without KRT: adjusted odds ratio, 1.81; 95% confidence interval, 1.40 to 2.33; P<0.001; AKI with KRT: adjusted odds ratio, 2.45; 95% confidence interval, 1.52 to 3.97; P<0.001), even after controlling for markers of critical illness (admission to intensive care units, mechanical ventilation, or modified sequential organ failure assessment score); however, consults came significantly later (10 days from admission versus 5 days; P<0.001). Similarly, 66% of patients initiated on KRT received palliative care versus 37% (P<0.001) of those with AKI not receiving KRT, and timing was also later (12 days from admission versus 9 days; P=0.002). Despite greater use of palliative care, patients with AKI had a significantly longer length of stay, more intensive care unit admissions, and more use of mechanical ventilation. Those with AKI did have a higher frequency of discharges to inpatient hospice (6% versus 3%) and change in code status (34% versus 7%) than those without AKI.ConclusionsPalliative care was utilized more frequently for patients with AKI and COVID-19 than historically reported in AKI. Despite high mortality, consultation occurred late in the hospital course and was not associated with reduced initiation of life-sustaining interventions.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_02_24_CJN11030821.mp3

Background: There has been a call by both patients and health professionals for the integration of palliative care with nephrology care, yet there is little evidence describing the impact of this approach. The objective of this paper is to report feasibility and acceptability of a pilot randomized controlled trial testing the efficacy of integrated palliative and nephrology care. Methods: English speaking patients with CKD stage V were randomized to monthly palliative care visits for three months in addition to their usual care compared to usual nephrology care. Feasibility of recruitment, retention, completion of intervention processes and feedback on participation was measured. Other outcomes included differences in symptom burden change measured by the Integrated Palliative Outcome Scale (IPOS)-Renal and change in quality of life measured by the Kidney Disease Quality of Life (KDQOL) questionnaire and completion of advance care planning documents. Results: Forty-five (67%) of 67 patients approached provided informed consent. Twenty-seven completed the study (60%), and 14 (74%) of those in the intervention group completed all visits. We found small improvements in overall symptom burden (-2.92 vs.1.57) and physical symptom burden scores (-1.92 vs. 1.79) in the intervention group. We did not see improvements in the quality-of-life scores, with the exception of the physical component score. The intervention group completed more advance care planning documents than controls (five health care proxy forms completed vs. one, nine Medical Orders for Life Sustaining Treatment forms vs. none). Conclusions: We found that pilot testing through a randomized controlled trial of an ambulatory integrated palliative and nephrology care clinical program was feasible and acceptable to participants. This intervention has the potential to improve the disease experience for those with non-dialysis CKD and should be tested in other CKD populations with longer follow-up.